Risk Factors for Psychotic disorders in patients with temporal lobe epilepsy

D´ALESSIO L, GIAGANTE B, IBARRA V, PAPPAYANNIS C, ODDO S, SOLIS P, SILVA W, DONNOLI V, CONSALVO D, KOCHEN S.

Helsinlki

Congreso; European Congress on Epileptology; 2006

Purpose: Temporal lobe epilepsy patients are at higher risk for acute and chronic psychotic disorders but the aetiology of this association is not clearly defined. The aim of this study was to determine risk factors for psychosis in temporal lobe epilepsy patients.Temporal lobe epilepsy patients are at higher risk for acute and chronic psychotic disorders but the aetiology of this association is not clearly defined. The aim of this study was to determine risk factors for psychosis in temporal lobe epilepsy patients. Method: 118 patients with neurological, neurophysiologic and neuroimaging criteria for temporal lobe epilepsy were included. Two groups of patients were determined: 61 patients (52%) with psychotic disorders codified in Axis I of DSM IV were compared with 57 patients (48%) without psychotic disorders. Psychotic disorders were defined by DSM IV criteria (SCDI I and II), and postictal and/or interictal psychoses were additionally diagnosed. Sex, age, age of epilepsy onset and epilepsy time duration, febrile convulsions, generalised seizures, status history, presence of unilateral and bilateral hippocampal sclerosis, and laterality of epileptic discharges diagnosed by video-EEG were determined. Student t-test and Chi Square were carried out.118 patients with neurological, neurophysiologic and neuroimaging criteria for temporal lobe epilepsy were included. Two groups of patients were determined: 61 patients (52%) with psychotic disorders codified in Axis I of DSM IV were compared with 57 patients (48%) without psychotic disorders. Psychotic disorders were defined by DSM IV criteria (SCDI I and II), and postictal and/or interictal psychoses were additionally diagnosed. Sex, age, age of epilepsy onset and epilepsy time duration, febrile convulsions, generalised seizures, status history, presence of unilateral and bilateral hippocampal sclerosis, and laterality of epileptic discharges diagnosed by video-EEG were determined. Student t-test and Chi Square were carried out.t-test and Chi Square were carried out. Results: The more frequent DSM IV psychotic disorders diagnosed were brief psychotic disorders (39%), schizophrenia (24%) and schizophreniform disorder (13%). Postictal psychotic episodes were reported in 29 patients with DSM IV psychotic disorders (47%). Topiramate in 4 patients and vigabatrin in 1 patient induced interictal psychosis (8%). Age of epilepsy onset was earlier and epilepsy time duration longer in the psychotic group, compared with the control group: p = 0.04 / p = 0.017. Status epilepticus history, and bilateral hippocampal sclerosis were more prevalent in psychotic patients p = 0.02 / 0.00.The more frequent DSM IV psychotic disorders diagnosed were brief psychotic disorders (39%), schizophrenia (24%) and schizophreniform disorder (13%). Postictal psychotic episodes were reported in 29 patients with DSM IV psychotic disorders (47%). Topiramate in 4 patients and vigabatrin in 1 patient induced interictal psychosis (8%). Age of epilepsy onset was earlier and epilepsy time duration longer in the psychotic group, compared with the control group: p = 0.04 / p = 0.017. Status epilepticus history, and bilateral hippocampal sclerosis were more prevalent in psychotic patients p = 0.02 / 0.00. Conclusion: In this study longer evolution, status epilepticus history, and bilateral hippocampal sclerosis (risk factors for epilepsy severity) were significantly more frequent in patients with psychotic disorders.In this study longer evolution, status epilepticus history, and bilateral hippocampal sclerosis (risk factors for epilepsy severity) were significantly more frequent in patients with psychotic disorders.